Mechanical Thrombectomy in Acute Ischemic Stroke Patients Greater than 90 Years of Age: Experience in 26 Patients in a Large Tertiary Care Center and Outcome Comparison with Younger Patients

Sweid, Ahmad; Weinberg, Joshua; Xu, Vivian; Shivashankar, Kavya; Alexander, Tyler; Khalife, Jane; Elmer, Nicholas; Gooch, M. Reid; Herial, Nabeel A.; Chalouhi, Nohra; Jabbour, Pascal; Rosenwasser, Robert H.; Tjoumakaris, Stavropoula

doi:10.1016/j.wneu.2019.10.024

Cited by 17 publications

(13 citation statements)

References 13 publications

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“…The poor outcome among nonagenarians treated with MT was driven largely by the severity of pre-existing functional deficits rather than by age itself. The past study reported in-hospital death of patients ≥90 years old treated with MT as 7-29%, 12,[17][18][19][20] which was similar to our present study (16%). The result suggests that the MT procedures do not directly cause patients death in ≥90-year-old group, but management of post-stroke complications, especially respiratory ones, and pre-existing comorbidities is important.…”

Section: Discussionsupporting

confidence: 91%

“…16) Another three reports also showed comparable effects of MT between patients ≥90 years old and younger patients. [17][18][19] On the contrary, Khan et al revealed that ≥90-year-old patients had poor functional outcome at 3 months compared with <90-year-old patients. 11) However, the mRS at 3 months was similar in both groups in a stratified analysis according to the pre-stroke mRS.…”

Section: Discussionmentioning

confidence: 99%

“…There are six retrospective studies, including our analysis, investigating the efficacy of MT for patients ≥90 years of age relative to patients <90 years of age. 11,[16][17][18][19] Sussman et al evaluated 108 patients with AIS treated between 2010 and 2018. Twenty-seven percent of the patients was ≥90 years old, and these patients population was similar to our study.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Kawaji

Tomoto

Arakawa

et al. 2021

Neurol. Med. Chir.(Tokyo)

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Mechanical thrombectomy (MT) is a proven treatment for acute ischemic stroke (AIS). However, the efficacy of this treatment is uncertain for very elderly patients. This study aimed to investigate the safety and effectiveness of MT in 90 years or older patients compared with younger patients. We retrospectively reviewed AIS patients treated with MT between October 2018 and June 2020 in our institution. Patients were divided into two groups: aged ≥90 and <90 years. We compared the following factors: functional outcome at discharge, in-hospital death, successful recanalization, and complications. Multivariate logistic regression analysis for the good functional outcome was performed. In consideration of pre-stroke basic activities of very elderly patients, we defined the good functional outcome as modified Rankin Scale (mRS) 0-3. In all, 66 patients were included, and 19 patients (28%) were ≥90 years old. Pre-stoke mRS was higher in ≥90-year-old patients (p = 0.01). In ≥90-year-old patients, we achieved successful recanalization in 17 patients (90%), and only one patient experienced hemorrhagic complication related with the procedure. The good functional outcome (mRS: 0-3) at discharge were six patients (32%) in ≥90 years old versus 19 patients (40%) in <90 years old (p = 0.6). Three patients died in hospital in each group (16% versus 6%) (p = 0.3). Only the stroke severity was negatively related with the good functional outcome in a multivariate analysis. In conclusion, for ≥90-year-old patients compared with younger patients, MT is an equally feasible therapy. Patients should not be excluded from MT based on age alone.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Kawaji

Tomoto

Arakawa

et al. 2021

Neurol. Med. Chir.(Tokyo)

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“…In addition, the resistance caused by atherosclerotic stenosis during the procedure of mechanical thrombectomy may tear some cerebral vessels and induce intracerebral hemorrhage (10). Despite these complications, mechanical thrombectomy has been reported to have a higher rate of recanalization and lower mortality in ischemic stroke patients compared to intravenous or intra-arterial thrombolysis (11)(12)(13). However, only a limited number of studies have investigated the efficacy of mechanical thrombectomy in acute ischemic stroke patients caused by VBAO, especially in the Chinese population.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Yao¹,

Xu²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: The mortality of acute ischemic stroke patients caused by vertebrobasilar artery occlusion (VBAO) is high and mechanical thrombectomy has gradually become a promising treatment for acute ischemic stroke. This study analyzed the efficacy of mechanical thrombectomy and the risk factors associated with poor outcomes in VBAO patients caused by severe local atherosclerotic stenosis.Methods: This retrospective study enrolled patients with acute ischemic stroke caused by VBAO between March 1, 2016 and August 31, 2019. Patient demographic and clinical data were collected retrospectively. All enrolled patients were retrospectively interviewed for at least 3 months. Patients with a modified Rankin scale (mRS) score between 0 and 3 points were defined as having satisfactory outcomes while those with more than 3 points were defined as having unsatisfactory outcomes. In-hospital mortality, the rates of recanalization, and the rates of intracerebral hemorrhage were also recorded. Multivariable logistic regression was used to determine the risk factors of unsatisfactory outcomes in enrolled patients.Results: A total of 65 patients were enrolled in this study with a median age 69.0 (63.0-78.0) years and 48 patients (73.8%) were male. Approximately 50% of patients had a mRS score of 0 or 1 point within 90 days after treatment with mechanical thrombectomy and 14 patients had a mRS score of 6 points. A total of 11 patients died in hospital. Out of the 65 patients, 7 required recanalization and 9 patients suffered from intracerebral hemorrhage. Multivariate logistic regression analysis showed that older age, lower baseline posterior circulation acute stroke prognosis early CT score (pcASPECTS), higher baseline National Institutes of Health stroke scale (NIHSS) score, and residual stenosis were independent risk factors of both unsatisfactory outcomes and mortality of VBAO patients.Conclusions: This study confirmed the important role of mechanical thrombectomy in the treatment of acute ischemic stroke caused by VBAO and may provide some guidance for improving the prognosis of patients.

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“…In our series, only 12.7% of nonagenarians achieved a good functional outcome at 90 days after the procedure with a mortality of 46.5%. Based on small retrospective cohorts, other studies have reported good functional outcomes ranging from 13 to 71.4% and mortality rates ranging from 7.7 to 71.6% [9, 13, 25, 33-38] with the best results occurring in series with highly selected patients [37] and strict inclusion criteria based on advanced imaging [36, 38]. Despite the relatively poor outcomes in very elderly patients in this series, these results should be interpreted in the context of the dismal natural history of acute ischemic stroke in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Age and Outcome after Endovascular Treatment in Anterior Circulation Large-Vessel Occlusion Stroke: ETIS Registry Results

et al. 2020

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Background: Increasing patient age has been identified in clinical trials as a poor prognostic factor for functional independence after endovascular treatment (EVT) for acute ischemic stroke. These findings may not be fully generalizable to clinical practice due to strict inclusion and exclusion criteria in these trials. We aim to assess and quantify the association of patient age, especially in patients >80 and >90 years old, with functional outcome after EVT in current, everyday clinical practice. Methods: The ETIS (Endovascular Treatment in Ischemic Stroke) Registry is an ongoing, prospective, observational study of 6 comprehensive stroke centers in France. We analyzed 1,708 patients treated between January 2017 and December 2018 and assessed the association of patient age with functional outcome adjusting for demographic and procedural predictors of functional outcome. Results: The positive effect of mechanical thrombectomy diminished significantly with increasing age: compared to the 18–80 years age group, the odds for achieving a good functional outcome at 90 days after the procedure decreased in the 80–90 and >90 years groups (multilevel OR: 0.38, 95% CI: 0.28–0.51 and OR: 0.2, 95% CI: 0.09–0.45, respectively, p < 0.001). Increasing age was associated with increased mortality (multilevel OR: 2.46, 95% CI: 1.72–3.54 for the 80–90 years group and multilevel OR: 5.49, 95% CI: 2.97–10.16 for the >90 years group). Conclusion: Patient age is strongly associated with functional outcome after EVT for acute ischemic stroke. The positive effect of thrombectomy persists in older age groups, even after adjustment for prognostic factors related to poor functional outcome. Stroke physicians should provide EVT irrespective of the patient’s age.

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Mechanical Thrombectomy in Acute Ischemic Stroke Patients Greater than 90 Years of Age: Experience in 26 Patients in a Large Tertiary Care Center and Outcome Comparison with Younger Patients

Cited by 17 publications

References 13 publications

Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

The efficacy and risk factors of mechanical thrombectomy for the treatment of vertebrobasilar artery occlusion: a single center study

Age and Outcome after Endovascular Treatment in Anterior Circulation Large-Vessel Occlusion Stroke: ETIS Registry Results

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